Medicare planning for women and their families can be confusing.
Should you get a Medicare Advantage plan?
What about Medigap?
When do you enroll?
The list of questions is nearly endless.
That’s why, on this episode of Women’s Retirement Radio, I’m excited to be joined by Danielle K. Roberts, co-founder of Boomer Benefits.
Click the play button below to listen to my conversation with Danielle:
Danielle and Boomer Benefits are based in Fort Worth, Texas, and serve clients across the country by helping them evaluate and make more informed decisions about their Medicare coverage.
In this episode, we cover many things related to Medicare including:
- When you should start thinking about Medicare
- Some aspects of Medicare that are surprising to many
- And a couple of great stories about how Boomer Benefits have helped folks like you out with their Medicare coverage
Here are some of the resources mentioned in this episode:
- Boomer Benefits Website
- Danielle’s LinkedIn Profile
- Wealthcare for Women’s Medicare Resources Page
- Boomer Benefits on Social Media
- Learn Medicare 6-Day Mini Course
Thanks for listening. I invite you to subscribe and share this podcast with your friends and family.
Medicare Planning for Women Episode Transcript:
Hey everyone, and welcome to another episode of Women’s Retirement Radio. I’m your host Russ Thornton. And today I’m really excited to have a guest on to talk about all things Medicare. As I work with and speak to issues around retirement for women and their families, one of the big topics that causes a lot of confusion, a lot of questions and seems to ever be changing is Medicare. And so I’m really excited to have the founder of Boomer Benefits, Danielle Roberts on the line today to talk a little bit about Medicare, her company, what they do and how they might be a great resource for you. So Danielle, welcome.
Hi. Thank you so much for having me.
Glad you’re here. And why don’t you take just a moment and introduce yourself, tell folks a little bit about yourself, your company and then we can go from there.
Sure. So I am Danielle Roberts. I’m the co-founder of Boomer Benefits and we are a licensed insurance agency that helps baby boomers navigate their entry into Medicare across 48 states. This business is one that I started just with my brother and I back in 2005 and we quickly were asked lots of health insurance questions from people. You had parents aging into Medicare. So although we originally started our business in the group and individual health insurance market, baby boomers were kind of on the forefront getting ready to age into Medicare. And this is pretty confusing stuff.
You spend your life having your health insurance options chosen for you by an employer and then suddenly you retire and you’re thrown into this beast of a national healthcare system with four parts and 10 supplements and literally thousands of drug plan options. And so we specialized in this area and have continued to grow the business. Today we have almost 60 employees licensed in states around the country that can help baby boomers with everything they need to learn about the parts of Medicare when they’re new to Medicare, make sure they have the education to get that part down and then we sell them supplemental insurance or help them enroll in drug coverage so that they can be comfortable and able to have medical treatment without worrying what kind of bills are going to come on the back end.
Well, thanks for sharing all that. I mean, it sounds like you guys have kind of pivoted from maybe the original company vision and have grown and really staffed up to address the ever-changing Medicare landscape out there. You’re based in Texas, right?
That’s right. Our call center is here in Fort Worth.
Right. But as you mentioned, you guys have agents that are licensed in virtually all the United States, correct?
Yeah, that’s right. We are currently not in New York or Massachusetts, but even in those two states, I have wonderful agents that I can refer people to. So if Medicare is something you’re beginning to dive into and you need a resource, we can help you a bit virtually where no matter where you live.
So one of the reasons I was really excited to have Danielle on the podcast today is in my work I’m constantly getting asked questions about Medicare. I frankly know just enough to be dangerous. And very recently, I reached out to and had a conversation with Danielle’s company, Boomer Benefits and have actually set up a dedicated webpage on my website that connects clients and potential clients and other folks that are just looking for education with resources that Boomer Benefits provides.
There’s a free email course, there’s a short video webinar people can watch and obviously there’s contact information so people can reach out to Boomer Benefits and learn more or get specific advice about your Medicare election options and your choices and how to set up the best coverage for yourself. Danielle, since you guys have been doing this for years, you’ve got a lot of employees and a lot of resources there, I know having spent time on your website, you guys spent a lot of time creating educational resources because I see you on social media and that sort of thing. Can you talk a little bit about what you guys do beyond actually just agents talking to potential clients about their coverage?
One of the things about Medicare that a lot of people don’t realize is about a year before you turn 65 and you’re eligible for Medicare, you start to get a few postcards and then it will turn into postcards and flyers and then it’s postcards, flyers, packets, and literally this daily use of mail that comes in. And almost all of that is from insurance companies trying to solicit you for one of the Medicare supplemental products that they sell. And it’s unfortunate because it’s really overwhelming to people who aren’t quite ready to make those decisions yet.
And so I think it’s important that when people learn about Medicare, they start with the basics. They get the foundation down, they learn about what the parts are and understand how those parts are going to cover them and what those parts will cost before they have a conversation with an agent about something that is a product that they can buy to supplement that coverage. So the angle that we’ve taken at Boomer Benefits is, let’s take this really confusing government program and break it down into pieces and educate people first on what the federal government already provides them, what access that thrives them, which doctors they can see, how can they use their benefits, what’s covered, what isn’t?
Because it’s quite different in some respects from employer coverage you may have had all your working life. And so we’ve taken the angle of let’s educate the world, even people who have retiree coverage or Tricare or VA benefits and may never need our services. We’re going to educate everyone on how Medicare works and how it might coordinate with whatever coverage that you have. And then for the percentage of people that need just that, they can be one and done learn what they need to do, move on. They can just fire off an occasional question to us if they have it.
But then once we get everybody really educated on how the benefits work, then that group of people that do need to take the next step in defining their supplemental coverage and worrying about how that’s going to coordinate with their benefits and what it’s going to cover, it’s really a secondary step and we’ll be here if they need that. But education is the key and we really love doing that. A lot of the resources that we put out there with the webinar and the six day mini course are to achieve that.
And we get hundreds of emails from people with just a thank you because when they went to go somewhere else to learn, agents trying to sell them something, in some cases they don’t really need anything, especially if they have federal employee health benefits or Tricare. And so by taking a different approach and just offering the education up front in the no hassle environment, we serve everyone. We serve the part of the community that will need our help and also people that may not, but everyone walks away with the information that they need.
And I think that’s super important because as I think we both kind of acknowledged at the outset, Medicare can be extremely confusing. Just when you think you’ve got it figured out, the government changes programs or takes away certain offerings or changes how things work. So in your experience, Danielle, what have you identified that people think you guys do versus what you actually do or maybe put a better way, what are people’s maybe misconceptions or when you have a conversation or one of your agents has a conversation with someone about Medicare, have you found there are common misconceptions about what Medicare is, how it works and how you guys find yourselves often bridging that education gap and explaining things to them?
Yeah, there’s a lot of misinformation out there and people confuse Medicare in a couple of ways. They confuse Medicare and social security in terms of the enrollment dates. So you’re eligible for social security at 62. You file that early, you’ll have a reduced benefit. You wait to your full retirement age, you’ll have 100% of your benefit. If you delay it, you can earn even more in your social security benefit. And none of that has anything to do with Medicare. So you’re eligible for Medicare at 65 regardless of whether you signed up for social security at 62 or planning to delay it until 70.
And so one of the biggest misconceptions is people get that wrong and they fail to enroll in Medicare when they were supposed to. They wait until their social security full retirement age and then they find out they now have a lifelong penalty because they missed their open enrollment for Medicare at 65. So it’s really important that we get the word out that whether you are taking social security yet or not, everyone is eligible for Medicare at 65 and everyone has an initial moment period that is seven months long during which you were going to take some steps toward Medicare.
So even if you’re someone that’s still working for a large employer, that coverage is your primary insurance and Medicare would only be secondary. You should be enrolling in Medicare part A right at 65 even for no other reason for it to be helpful to you if you have an inpatient hospital stay, it can’t hurt you in most cases because most people don’t pay anything for part A, our taxes have prepaid that. And the only reason you wouldn’t enroll in that as if you’re still working and contributing to an HSA account where the IRS doesn’t want you to have any other type of coverage.
And lots of people will miss this. They may be missing opportunity to shore up their hospital benefits by adding Medicare as a secondary piece or they miss it all together and have a penalty later. So that would probably be one of the biggest ones that I could start with would be social security and Medicare have different enrollment dates and it’s important to understand those. And then the second piece would be Medicaid, which is another federal government program which is designed for people with low income and that’s a completely different program than Medicare.
But if you’re eligible for Medicaid, sometimes you might think you don’t need Medicare. And again, then you have someone missing their enrollment. So we really want people to know that three months before you turn 65, that’s when you should start relooking at Medicare, no matter what type of coverage you currently have, you should be learning about what Medicare provides and how it works with the type of coverage that you do have so that when your actual birthday comes around and there’s an action step that you need to take, you’ve done that and you don’t unwittingly walk into a penalty that’s going to follow you around for life.
Got it. That’s great. Thank you. And beyond that, I can only imagine that with all of the work that you guys do across virtually the entire United States and all the conversations you’ve had, looking back, is there a success story that just kind of rises to the top in your mind where you guys have really been able to help a person or a family out with their Medicare decision making?
Yeah. I mean, we get some really neat stories and every now and then you’ll have a client that literally is just in tears because they had been so confused and overwhelmed by Medicare and suddenly you’ve turned the light bulb on and they understand how it’s going. But sometimes the ones that you help are not even the ones that become your clients. One that I can particularly remember, this one has been probably eight or nine years ago. A long time couple of mine had been my clients for several years, told us about a friend who was paying over a thousand dollars a month for her Medicare supplement, which certainly does not sound right because they’re not anywhere nearly that expensive in those cases.
So I had this lady into the office and met with her and what I was able to determine by looking through her records and helping her piece this together is that when she turned 65, she signed up for Medicare and enrolled in a supplement. And then later the annual election period came around and she was a little nervous thought that maybe she didn’t have enough coverage, enrolled in another supplement. And this happened about five different times to where now this woman literally had five different Medicare supplements, only one of which was doing any good for her because you can’t get more than one Medicare supplement benefit.
Medicare only records one of them as your supplement in their database. So she was literally spending over $800 a month for four supplements that she never needed probably because agents that she dealt with didn’t ask the right questions or didn’t help her with canceling a supplement when they were selling her a new one. And it was just so wonderful to usher her out that day and not make a dime, but to know that this poor woman living on social security and not much more was now going to save thousands of dollars a year for coverage she never needed it in the first place. And I’ve never forgotten how great that felt.
And that’s kind of the spirit with which we run the agency now, which is let’s help everyone with all the information that they need and then those that need to work with us for something more, great. But we love the opportunities like that one to do a little good in the community. And that’s just a really good example of how the lack of knowledge out there could really financially harm someone quite a bit.
What a great story. I mean, it’s unfortunate she found herself in that position, but luckily her friends were able to connect her with you guys so you all could straighten things out and reduce her costs by quite a bit. I mean, that’s ridiculous sounding.
A lot of money for her.
Yeah, no kidding. I know that story you just gave was about a woman that had unwittingly bought multiple supplemental coverage and was paying multiple premiums. But this podcast is all about women and women preparing for retirement. So as you think about kind of the landscape of Medicare, is there anything unique to women that’s part of the work that you do or that you’ve experienced that maybe women should be particularly aware of or consider as they maybe approach Medicare enrollment age or maybe they’re already Medicare eligible and they’re coming up to open enrollment again later this year, is there anything they should be aware of specific to themselves?
Yes. So of course women should always be planning for healthcare costs and retirement. Everyone has those costs, but as women, our life expectancy is longer and so there needs to be some additional planning there. You need to be aware that Medicare covers medically necessary treatment. One of the things that it doesn’t cover is longterm care. And so often as women get older, sometimes our spouses die before we do. And eventually there comes a point where we can’t care for ourselves any longer and we need to have help with living in an assisted living or a nursing home situation.
We don’t like to think about this, right? Because it’s far off in the future and it certainly doesn’t sound like something fun, but it’s really important that when you’re working in setting up your Medicare benefits that you understand the limitations of those benefits and you have a separate plan for how someday you’re going to pay for any necessary longterm care that you have. You can enroll in the longterm care insurance policy. Shopping for those in your 50s is a great time to do that because you can get them reasonably inexpensively and you have that money set aside.
I don’t offer those types of policies but I did work with an agent that I know is a specialist and had her meet with my parents and we set that up so that I had a policy set up that would allow my mom and dad to live independently in their own home as long as possible before having to make a step and so that would have the coverage provide for all of those things. If doing a longterm care insurance isn’t in your wheelhouse or that’s not something you have in mind right now, there needs to be some thinking at some point and certainly some work that you do with your financial planner to plan for how are we going to pay for those things in the future.
Also, dental, vision and hearing is another thing that Medicare doesn’t cover and these are things that need to be in your plan. How am I going to pay for that when the time comes and I’m 65 and I no longer have a dental plan through my employer or a vision plan through my employer? Should I open up a health savings account right now and put some money away and save that money up for a rainy day? These are considerations that impact women more because we live longer, we also spend often many of our years just before that being a caregiver for someone else. And this is a time of your life where you will be so absorbed in taking care of that person that you may not be thinking about your own future at all, but it is something you do need to think about.
And so I think women have a pretty good burden in terms of the outlook and the planning that goes in upfront. But I am really excited to share that over the last decade I’ve really noticed a shift in the type of clients that we deal with. Back in 2005, 2006 a lot of times we were dealing with the man in the household, but I would say today about 70% of the policyholders that I’m dealing with directly are women and they’re setting up their Medicare coverage for themselves and their husband. And I love to see that, the women taking charge of the insurance arena and planning those things out. And so there’s an opportunity here for them to get educated and to know these things and prepare for them before those costs of longterm care and other things come at them.
Well, what came to my mind hearing you explain that is how you originally started your agency with your brother and you had clients approaching you with questions about their own parents who are aging, who are likely in many cases dealing with some of the issues you just outlined, whether it’s a longterm care need or just one spouse maybe needing to transition to more of a caregiver role. So if you’re listening to this episode and you’re not anywhere near Medicare eligibility, age 65 but maybe your parents are either approaching 65 or well into their sixties or seventies these are issues that you might want to discuss with them if you haven’t already and make sure that they have a plan in place, whether that involves longterm care insurance or not.
Just kind of get those issues out on the table, talk about it, and make sure that you kind of know how they want to be taken care of and how they want those issues handled in the event those needs should arise. Danielle, I think you might’ve touched on this talking about the fact that Medicare does not cover longterm care needs specifically, but have you found another big surprise with clients when they talk to you about either Medicare or supplemental coverage? Either it’s maybe a misunderstanding about coverage or just how the system works. What would you say is the biggest surprise that people often learn after they engage and have conversations with you and your staff?
So probably one of the biggest ones is surrounding Medicare’s election periods. When you first become eligible for Medicare, you have this six month, one time window, we call it your golden ticket. It’s a time when you can enroll in a Medicare supplement with no health questions asked, which is very critical if you have a serious health condition. So you’re going to be aging to Medicare and that’s your primary insurance and there’s no preexisting conditions with that, you’ll always be covered for anything that you come in to Medicare with or that you develop later on Medicare.
But supplemental coverage does not fall under the same laws, the affordable care act made some changes for people under 65 to now where they can’t turn you down for having a preexisting condition. Those plans are primary coverage. Medicare does the same for you as primary coverage, but your Medicare supplement which covers your deductibles and covers 20% of your medical expenses and outpatient arena, which can include some expensive things like outpatient surgeries, physical therapy, chemotherapy, dialysis, radiation, things that can really be very financially straining if you don’t have a plan.
You’re going to need to purchase some type of coverage to help you get that and that coverage is secondary, it’s voluntary, it’s optional, which means the carriers can turn you down for that coverage. When you apply you have to answer health questions except for that six month window that starts with your part B effective date and you have this great opportunity to pick up a plan and never have to worry that any health questions are going to be asked. You don’t answer them, they can’t turn you down for that coverage due to any preexisting health conditions. And that goes away and it never happens again.
So people are used to seeing the TV commercials in the fall, Medicare annual election period, it’s your open enrollment for Medicare, time to sign up now. And they mistakenly think that they can just wait until a year when they get sick and then go sign up during the annual election period and get a Medigap plan with no health questions asked. And that is not the case because that annual election period in the fall is for choosing your drug plan or changing your drug plan. Or if you happen to have a Medicare advantage plan, which is type of private Medicare insurance, you can make changes on that. But it does not give you a free pass into a Medicare supplement with no health questions asked.
And I would say that in the webinars that we do, this is the one thing that generates the most questions. In fact, we just had a webinar earlier today and I had five or six questions about this afterward. Even though I’m explaining it in the webinar, just like I am with you now, it’s so hard for people to believe that they will ask at the end, did you say that I can’t sign up in the open enrollment? What about the affordable care act? I thought Obama changed this. And it’s because this coverage is secondary. So I would say that that’s one that really messes people up a lot of times and can result in them being unable to get the coverage that they may have bought if they knew the rules.
I think that just highlights something you’ve already said is just be aware of the timing and make sure you don’t get cross ways by missing the enrollment window and missing the opportunity to enroll without being challenged on any preexisting conditions and things of that nature. So if that’s a big surprise for a lot of clients, Danielle, what surprised you most about your work over the last several years?
There’s such a huge need for people to make sense of this stuff. That shift from employer coverage to Medicare is so abrupt for most people and it’s very surprising that the government does so little to help people with that. I always say, I wish there was a class at age 50 that you could go and sign up for that was going to tell you everything you needed to know about Medicare when you turn 65. And the reason I say 50 is because you would still have some time to do something about it. And you see so many people being caught off guard by the fact that Medicare isn’t free.
So we pay taxes all our working life. We see those FICA taxes coming out of our paychecks and we think that someday we’re going to get some Medicare and it’s going to cost us nothing and that it will cover everything, and that’s completely not the case. Medicare is actually really good insurance, but it works very similar to coverage you’ve had in the past. You will have a premium that you pay for it just like if you have employer insurance, your employer pays a portion and you pay a portion that’s deducted from your paycheck out of your payroll deductions, that’s your cost of the coverage.
You also buy coverage from Medicare for your outpatient coverage. So although those taxes, you’ve seen all your working life pay for your hospital coverage, you will pay a premium for both your outpatient coverage and your drug coverage. And people are really surprised and caught off guard by that. I can tell you, I get some very colorful emails about the federal government and people’s opinions of this because I’ve seen hundreds of people over the years that find this out too late and they either postpone their retirement and continue working for a few years to maintain that health coverage while they try to save up something toward Medicare.
Or they maybe knew that Medicare costs something, but they didn’t know that they still were going to have cost sharing as they go along. So on your current health plan, under 65 you’ve got a deductible, you have a copay at the doctor. These things exist in Medicare too. So in addition to paying premiums, you also are going to have a deductible when you go in the hospital, it’s currently around $1400. Your outpatient coverage even has a deductible, which is around $200 and then Medicare only covers 80%. So if we all had a class at age 50 to prepare us for this, we would probably age into Medicare in a better position.
But there really is no education on any level other than the government producing a Medicare and you hand book that you can download online that’s 120 pages and filled with insurance lingo that you won’t understand. And so you really have to take the bull by the horns and get this information on your own and get it early enough that you aren’t in a position really upside down and being unable to afford that coverage, especially if you were just living on social security.
Well, like you at Boomer Benefits, education is really important to me. So maybe we’ll have to schedule a webinar to continue this discussion at some point in the future. But I think to summarize what you’re saying, just like we’ve seen fewer and fewer corporate pensions or more pensions go away and more of the responsibility for preparing for your retirement falls to you, the individual. And with that, it calls for a lot of self education or finding an advisor or a professional or a team of professionals that can help you make informed decisions about all of these moving parts in retirement, not the least of which is Medicare.
I think ultimately you’re going to have to, like you said, take the bull by the horns, take more personal responsibility to both educate and prepare yourself for this. And like you said, even though enrollment is not till 65, it’s never too early to start thinking about and preparing and thinking about how you’re going to handle these decisions as they get closer and closer. Danielle, if there were one thing that women listening to this who are preparing for retirement, if there’s one thing that those women could take away from our conversation today or just from the work you do in general, what one thing would you want them to take away from our conversation today?
Probably that when the time comes and you are 65, you’re going to have a seven month enrollment window and the decisions that you make during that personal seven month window can and will affect your healthcare coverage for the rest of your life. So the earlier you start the research, the better. I actually think it’s a blessing sometimes when younger women, I’m 46 and dealing with this with my own parents now, their entry into Medicare, I was very involved in that. Of course, I’m in the field and that’s great. But had I not been, I know for sure I still would have been assisting my mom and dad with these decisions. And so sometimes doing that is great because you’re young enough to say, “This stuff is really confusing. I’m going to learn this now,” so that in 15 years or 20 years when it’s my time, I’ll be prepared.
And so anything that you can do to learn a little bit early is good. It’s always encouraging to me when we have the occasional person will send me an email after a webinar and they’ll say something like, “I’m only 55 but I saw this webinar and I thought it’s never too early to get started.” And I’m very impressed with people that do that because they’re going to be in such a much better position. So make sure when the time comes for you that you understand that seven month window backwards and forwards and you’ve done your research and you’re ready to make some decisions and nothing’s going to catch you off guard.
That’s great. And again, I think the underlying theme for this conversation could be just the earlier, the better that you can start thinking about and preparing and educating yourself to make the right decisions, especially given the lifelong impact they could have with regard to your health care and taking care of yourselves. I don’t think we could underline that point enough. As we start to wrap up, Danielle, I just want to cover a couple more things. I think you might’ve addressed this earlier, if you could just wave a magic wand and fix one thing about Medicare, either how it’s delivered or how it works, what’s the one thing that you might love to fix or be able to fix it and why does that come to mind for you?
I would love to be the CMS administrator for a day. I would have so many changes that I would make. And of course, the education piece that we discussed would certainly be one of them. But there’s also some hiccups that happen on the backend of Medicare that I see leave people stranded because you have all these moving parts. So you’ve got doctors that are providers and have over 70000 codes that they could use when they’re treating you. And that little code, that little circle that they put on their paper that goes to Medicare determines whether or not your claim gets paid. And if the claim doesn’t get paid, Medicare will send you a notice, but the notice only comes out quarterly.
So you’re getting bills from your doctor’s office wondering why Medicare hasn’t paid them and you don’t get your statement for quite a while. This can really be overwhelming. I know here we’ve got some clients in their nineties and they call us for just about everything, especially the ones that don’t have adult children. And I always wonder how do these people that don’t have an agent, what are they doing out there? It’s probably cost prohibitive, but I just wish there was some sort of assistance, a Medicare navigator or just someone that you got assigned to you, if it was on a state by state basis and it was a few simple things like a webinar, how to read your Medicare summary notice.
Telling them about signing up for mymedicare.gov, there’s my social security at gov and mymedicare.gov and these are two free accounts you can register online that will give you so much information on what’s going on with your benefits. And nobody has ever told about them. So unless they stumble across these things, they never find them. So I think there’d be a big communication effort. That’s what I really like to wave my magic wand. What are all the ways that we can provide opportunities for people to get educated and also how to handle things when they run into them on the backend?
Someone for them to call that they could reach out to because this is a time of life when the last thing you want to be doing is making decisions. Especially if your employer always, your whole life, gave you two plans and said pick one of these. So suddenly for us into a national health insurance program as a nation, we need to do a much better job of communicating with people about what their benefits are and what they include and what they don’t.
I don’t want to be presumptuous about this, but I’m assuming your company Boomer Benefits is at least one resource that people can call to get questions answered and help evaluate certain choices and make better decisions. Is that fair to say?
Yeah. You bet. And so we’re always out there trying to make people aware that we exist. And sometimes they’ll say, “I saw you on Facebook. I didn’t even know there were brokers that did this.” So there’s a lot more communication that needs to be done so that people know how to find that information, whether that be from the federal government or from a broker like us.
Got it. Before we start to wrap things up, can you share another story that is particularly memorable for you about maybe a client or how you guys have helped someone with Medicare?
Yes. So I’ve got so many good ones that I could tell you. One of the things when you first become eligible for Medicare is you have a choice between enrolling in a Medicare supplement or a Medicare advantage plan. And advantage plan is a way that you can get your benefits through a private local network. And these plans are often a lot less expensive than supplements, but you’re using a local network of doctors.
So if you had original Medicare, you’ve got over 1 million providers nationwide that you can see. With an advantage plan, you might have 5000 providers just in a couple of counties around your home. And it’s really important that you think about that when you’re making your coverage decisions because sometimes people will make a choice simply because someone in Sunday school or a girlfriend of theirs or an uncle or cousin or someone enrolled in a plan and likes it. And then that coverage really may not be very good for you.
So I can think of one gentleman that enrolled, he was very dead set on enrolling in a Medicare advantage plan. He liked the plan, the plan was inexpensive and he was pretty healthy. And this story is a good example of we always should plan for the worst case scenario. So we enrolled him with the Medicare advantage plan, we explained how it worked and it seemed like a good fit at the time. One of the things I always inform our clients about is, this coverage later on when you do have some medical usage, you have to pick a primary care provider on some plans. You’ve got to see your primary care doctor to get a referral. And those things are hassles when they come about and you need to think about whether you’re okay with that.
This gentleman, 11 months into his Medicare advantage plan, started having fluid building up in his stomach and he went to the doctor, went to the hospital. They finally found out that he was in early stage liver failure. He didn’t have cirrhosis, was never a heavy drinker. Really no one could figure out why this was happening to him. And it turned out that the only hepatologist available in this network couldn’t see him for about eight weeks because he was so booked up, there were only six hepatologists in the entire network. And this is the DFW area plan, Dallas Fort Worth, which is a very large urban market.
And so there’s a little feature with Medicare advantage plans where if you try one right out of the gate and during the first 12 months you decide you’re unhappy, you can go back to original Medicare, pick up a supplement, no health questions asked and you’re good to go. And so when I saw what was happening, this gentleman was going into the ER every couple of days to have his fluid drained from his abdomen. I called him up and I’ll say, “You know when I told you about, we’ll never know what’s going to happen tomorrow with our health? Well, yours happened just in the nick of time. We need to use this 12 month window for you to go back to original Medicare. Get out of this, let’s get you on a Medigap plan where I can find you a hepatologist because there’s a million providers in the United States.”
And we were able to use that one little window, that one little feature there to get him out of the coverage that would’ve been so terrible for him and get him into one was good. But I shuddered to think what might’ve happened if he’d called me with this happening in the 13th month or I wouldn’t have been able to move him around. So one of the things that that story demonstrates is there’s a lot of complexity here to these parts. And working with a broker, an expert in Medicare can really benefit you because there’s many things like that that we know how to fix or we know what to suggest that you may not.
So for the same reasons why we hire a financial planner, consider working with someone that’s an expert in Medicare so that you don’t get caught off guard and so that someone does explain to you all of the options available to you and might be able to suggest something for your particular situation that would be helpful. And I think it’s also a good story indicative of why when you purchase health insurance, it should always, always be the coverage that you want if the worst case scenario happens tomorrow. Don’t always just go with something that someone else likes or something that costs very little and this is important stuff that we’re dealing with and you never want to be in a situation like he was where you desperately need to see a specialist and you just don’t have access to one.
Well, I mean that’s just another great example of how detailed and intricate the maze of Medicare can be in and to your point, why it’s important to have an expert that you can talk to and help you make those right decisions, and hopefully get them right the first time, but to also be aware of the options and alternatives that are available to you should you need to make a change like that gentleman did. So that what a great story. I think that’s maybe a great place to wrap up. I feel Danielle, we could probably talk for another hour about the wonderful world of Medicare. So like I said, we’ll have to continue this conversation another time or maybe set up a webinar at some point.
I could do that.
But I want to thank you for joining us today. For folks that are listening, Danielle, what is the best way for them to get in touch or learn more about who you are, about Boomer Benefits and how you might be able to help them with Medicare?
So we are online at boomerbenefits.com. You can find our website and from there you can sign up for a number of free educational resources, some of the ones that you have mentioned Russ. And when you enroll in these programs you can learn by video, there’s an email course that you can sign up for. You can attend a webinar and ask questions. We also have stuff that you can consume on your own time. So you go to our YouTube channel and we’ve got lots of great educational videos there. And we have a Facebook group. So if you go to Boomer Benefits on Facebook, you can follow our page, we have almost half a million followers and we also have a private Facebook group, which you can join where you can pose your questions directly to myself and I will answer them for you and several members of my team are in there as well.
And one of the things I think that we do good with is just educating people from the perspective of we know that Medicare is not fun or sexy and it’s the last thing in the world that you want to have to go learn about, but because it’s a requirement, we keep it short and sweet and as painless as possible. So those are some resources that you could look at in your own time and just have there in your back pocket. So when the time comes and you have questions you’ve got somewhere you can go to get those answers.
That’s great. Thanks. And I’ll be sure to share links to those resources in the show notes of this episode once we get it published. I can only speak to my experience dealing with Danielle and the folks over at Boomer Benefits. They’ve been great and super helpful in speaking both with me as well as my clients and other folks that I’ve pointed to them. So I would definitely encourage anyone that’s listening, if you have questions about Medicare or even if you just want to get a second opinion on what you’ve already decided to do with your Medicare, reach out to Boomer Benefits. I know they’d be happy to speak with you and help or point you to one of their many educational resources. With that, let’s wrap it up for today. Again, I appreciate all you out there listening. This has been Women’s Retirement Radio. I’m Russ Thornton and Danielle, thanks again for joining us and I look forward to speaking to all of you guys again soon.
My pleasure and thank you.
Hey there, Russ again. Some quick disclosure language for you. You should consult a financial advisor familiar with the specific circumstances of your unique financial situation before making any financial decisions. Nothing in this broadcast constitutes a solicitation for the sale or purchase of any securities. Any mentioned rates of return are historical or hypothetical in nature and are not a guarantee of future returns. I’m a financial advisor, a certified divorce financial analyst, and an investment advisor representative of Wealthcare Capital Management LLC, an SEC registered investment advisor based in Richmond, Virginia. The views discussed in this podcast are my own and may not be consistent with or represent those of Wealthcare Capital Management.